Vassallo Michael, Vignaraja Raj, Sharma Jagdish C, Hallam Helen, Binns Kath, Briggs Roger, Ross Ian, Allen Steve
Ashfields Community Hospital, Kirkby-in-Ashfield, United Kingdom.
J Am Geriatr Soc. 2004 Mar;52(3):335-9. doi: 10.1111/j.1532-5415.2004.52102.x.
To determine whether a change in practice to introduce a multidisciplinary fall-prevention program can reduce falls and injury in nonacute patients in a rehabilitation hospital.
A quasi-experimental study.
Three geriatric wards with a similar design, equipment, staffing levels, and skill mix.
Eight hundred twenty-five consecutive patients.
The patients' fall-risk status was assessed using the Downton Score. Current practice was maintained on the two control wards (n=550). On the experimental ward (n=275), a fall-prevention program was introduced. A multidisciplinary team met weekly specifically to discuss patients' fall risk and formulate a targeted plan. Patients at risk were identified using wristbands; risk factors were corrected or environmental changes made to enhance safety.
Primary outcomes were number of fallers, recurrent fallers, total falls, patients sustaining injury, and falls per occupied bed days. Secondary outcomes were place of discharge and mortality.
Patients were matched for age and risk status. Control wards had proportionally more fallers (20.2% vs 14.2%: P=.033), patients sustaining injury (8.2% vs 4%: P=.025), and total number of falls (170 vs 72: P=.045). These results did not remain significant after controlling for differing length of stay. There was no reduction in recurrent fallers (6.4% vs 4.7%: P=.43) and no effect on place of discharge (home discharges; 57.5% vs 60.7%: P=.41) or mortality (15.3% vs 13.8%: P=.60).
This study shows that falls might be reduced in a multidisciplinary fall-prevention program, but the results are not definitive because of the borderline significance achieved and the variable length of stay. More research on fall prevention in hospital is required, particularly as to what interventions, if any, are effective at reducing falls in this group of patients.
确定引入多学科预防跌倒计划的实践变化是否能减少康复医院非急症患者的跌倒及损伤情况。
一项准实验研究。
三个设计、设备、人员配备水平及技能组合相似的老年病房。
825名连续收治的患者。
使用唐顿评分评估患者的跌倒风险状况。两个对照病房（n = 550）维持现行做法。在实验病房（n = 275）引入了预防跌倒计划。一个多学科团队每周专门开会讨论患者的跌倒风险并制定针对性计划。使用腕带识别有风险的患者；纠正风险因素或进行环境改变以提高安全性。
主要结局指标为跌倒者数量、再次跌倒者数量、跌倒总数、受伤患者数量以及每占用床位日的跌倒次数。次要结局指标为出院地点和死亡率。
患者在年龄和风险状况方面相匹配。对照病房的跌倒者比例更高（20.2% 对 14.2%：P = 0.033）、受伤患者比例更高（8.2% 对 4%：P = 0.025）以及跌倒总数更多（170次对72次：P = 0.045）。在控制不同住院时长后，这些结果不再具有显著性。再次跌倒者数量没有减少（6.4% 对 4.7%：P = 0.43），对出院地点（回家出院；57.5% 对 60.7%：P = 0.41）或死亡率（15.3% 对 13.8%：P = 0.60）也没有影响。
本研究表明，多学科预防跌倒计划可能会减少跌倒，但由于所达到的临界显著性以及住院时长的差异，结果并不确定。需要对医院内的跌倒预防进行更多研究，特别是关于哪些干预措施（如果有的话）对减少这类患者的跌倒有效。
